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The recently released Life in Rural America survey found that rural Americans are having a harder time these days accessing health care. Part of the problem is pure distance: “One out of every four people living in rural areas said they couldn’t get the health care they needed recently. And about a quarter of those said the reason was that their health care location was too far or difficult to get to,” Kirk Siegler reports for NPR.

Local health care isn’t available to many rural residents because so many rural hospitals have closed — more than 100 since 2010, with hundreds more in dire financial straits. Of the more than 7,000 areas in the U.S. with health professional shortages, almost 60% were in rural areas, Siegler reports.

Another big problem is that it’s hard to find replacements for retiring rural doctors. “As baby boomer doctors retire, independent family practices are closing, especially in small towns. Only 1% of doctors in their final year of medical school say they want to live in communities under 10,000; only 2% were wanted to live in towns of 25,000 or fewer,” Siegler reports. “Taking over a small-town practice is too expensive, or in some cases, too time-consuming for younger, millennial physicians. And a lot of the newly minted doctors out of medical training are opting to work at hospitals, rather than opening their own practices.”

Being a rural doctor also requires a different mindset. Christopher Wong, a family practice physician in Ogallala, Nebraska, said it was a difficult transition. “Being a doctor in a small town, you’re always on, even when you’re not. It’s not like you can just clock out and leave work. Wong will bump into a patient at the grocery store who politely asks about this ailment or that problem. Everyone knows him and there’s no anonymity,” Siegler reports.

“I think that’s why it’s also hard to get physicians into rural practice, because it’s hard to maintain a personal life,” Wong told Siegler.

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